Fit note: bill of health

Long-term sickness absence is one of the most complex issues facing HR professionals in the UK. It is also an expensive one, with absence and unemployment due to ill health costing the economy an estimated £100bn each year.

In 2007, the government commissioned national director for health and work, Dame Carol Black, to review the matter. Her subsequent March 2008 report, Working for a Healthier Tomorrow, recommended introducing a new Statement of Fitness for Work – or ‘fit note’ – system.

The government agreed, saying that the sick­note system wrongly encouraged sick employees to stay off work until completely fit.It hopes the fit note will cut the cost of sick leave for employers and benefit the UK economy by an estimated £240m over the next 10 years.

‘May be fit’

The fit note, which comes into force on 6 April, will ask doctors to tick one of two options regarding a person’s health: either that they are ‘unfit for work’, or ‘may be fit for work taking account of the following advice’.

Doctors are then told to list whether the employee would benefit from a phased return to work, altered hours, amended duties or workplace adaptations. The note does not, however, require them to provide details of activities an employee is able to perform.

This ambiguity about the detail that GPs will be required to provide will be a major stumbling block to the success of the fit note, according to HR chiefs and legal experts.

Linda Maughan, director of HR at Middlesbrough Council, warns that it could well lead to disputes between employers and staff. “There will inevitably be disputes about what constitutes suitable work,” she says.

Jane Hobson, employment partner at Weightmans, says that the new system could cause more problems than it solves. “[Fit notes] will ultimately mean more grievances and the potential for an increased number of employment tribunal applications,” she explains.

GP understanding

There is also a risk that the GP will recommend a course that is costly or not feasible for the employer, says Rachel Dineley, head of the diversity and discrimination unit at Beachcroft: “It will be all-important for GPs to understand the workplace environment and what, in practice, can be accommodated, to facilitate a return to work.”

Fit notes at a glance

The main changes are:

The removal of the fit-for-work option

A new option for a doctor to advise if an employee may be fit for work with some support

More space for a doctor to provide information on how the employee’s condition will affect what they do

Tick-boxes for doctors to use to suggest practical ways to help a return to work.

The government acknowledges that GPs will require training – they will be given access to the national occupational health helpline, as well as an e-learning programme, modules on the Royal College of General Practitioners website and detailed guidance accompanying the fit note.

But Hobson points out that GPs and employers will always have different priorities. “GPs are primarily the advocate of the patient they are treating and will have their health, and not necessarily their job, as their priority,” she says.

“Quite rightly, GPs are unlikely to want to compromise their relationship with their patient. The burden will remain upon employers to seek detailed information about an employee’s condition and then consider how the employee can be rehabilitated and what adjustments can be accommodated.”

Not legally binding

While the system is designed to get people who can work back into the workplace, employers need to be cautious and remember that the GPs’ recommendations are not legally binding, says Claire Hollins, employment law solicitor at Mace & Jones.

“GPs will have limited knowledge of the employee’s workplace and what their job entails,” she says. “The doctor’s recommendations are therefore really intended to encourage discussions between employer and employee to work out exactly what changes can be made to enable the person to work.”

Stephen Moir, corporate director of ­people, policy and law at Cambridgeshire County Council, says a more wide-ranging approach is needed to effectively address absence.

“This should include support for occupational health services to be made more accessible to more employers, fundamental benefits reform and, potentially, creating opportunities to ‘reward’ or otherwise incentivise employers with a strong track record in managing workplace absence,” he says.

But while Black admits it will take time for GPs to adjust to the new system, she insists that the fit note will be a success in the long term. “I don’t think on day one we will be in nirvana, but I do believe it is a fundamental cultural and mental change that you are no longer labelled sick, and for me that’s the most important thing,” she says.